Regional Disparities in Diabetes Care for Pediatric Patients with Type 1 Diabetes. A Cross-sectional DPV Multicenter Analysis of 24,928 German Children and Adolescents.

BACKGROUND: Data on regional differences in the quality of medical care in Germany are scarce. This study aimed to compare outcome quality and medical treatment of pediatric patients with type 1 diabetes between the federal states of Germany. METHODS: 24,928 patients (< 18 years of age) with type 1 diabetes and German residence were selected from the Diabetes-Patienten-Verlaufsdokumentation database. Indicators of outcome quality were HbA1C, overweight prevalence, and rate of severe hypoglycemia. To reflect medical treatment, use of insulin pumps and use of rapid-acting or long-acting insulin analogues were analyzed. Logistic regression models were created for binary variables with federal state as independent predictor. Linear regression was applied for HbA1C and Poisson regression for rate of severe hypoglycemia. Confounders: Sex, age, diabetes duration, migratory background. RESULTS: Disparity was observed for indicators of outcome quality between the 16 federal states of Germany (all p<0.05). After adjustment, HbA1C varied between 55.8 mmol/mol and 67.3 mmol/mol, overweight prevalence between 10.0 and 15.3%, severe hypoglycemia ranged from 0.06 events/PY to 0.21 events/PY. Overall, the best outcome quality appeared to be present in Saxony. Medical treatment also differed. The percentage of pediatrics on insulin pumps varied between 26.3 and 51.8%. The use of rapid-acting analogues ranged from 56.6 to 96.2% and the use of long-acting analogues varied between 41.9 and 96.9% (all p<0.0001). CONCLUSIONS: Medical treatment and outcome quality in pediatrics with type 1 diabetes differed within Germany. Disparities in individual socioeconomic status, regional deprivation, or differences in medical reimbursement decisions might have contributed to the patterns observed.

[Transient zinc deficiency in preterm infants]. / Transiente Zinkmangeldermatitis des Frühgeborenen.

Zinc is an essential element and necessary for various cellular functions. Preterm infants may have a negative zinc balance and are therefore especially susceptible for symptomatic zinc deficiency. We report on a preterm child with distinct clinical manifestations of zinc deficiency confirmed by histology and laboratory analysis who quickly healed with oral zinc therapy.

Detection of a mucin marker for the adenoma-carcinoma sequence inhuman colonic mucosa by monoclonal antibody AM-3.

The monoclonal antibody AM-3 was raised against mucins extracted from human colorectal carcinomas. It reacted strongly with sections of paraffin wax embedded colorectal carcinoma. In colonic adenoma tissue the percentage of cells expressing the epitope detected by AM-3 correlated with the degree of dysplasia. In contrast to immunohistochemical staining, which did not show the presence of the antigen in histologically normal mucosa, the more sensitive enzyme linked immunosorbent assay (ELISA) and immunoblot assays showed that it was weakly expressed in this tissue. AM-3 reacted with variable frequency with several normal and malignant human tissues, indicating that the detected epitope is not restricted to colonic tissue. In colonic carcinomas it is present on a sialomucin of apparent relative molecular mass of more than 440,000. These data suggest that the antigen detectable with AM-3 may be useful in the assessment of premalignant changes in colonic adenomas.

[Endosonography in early pregnancy]. / Endosonographie in der Frühschwangerschaft.

Vaginal sonography has brought tremendous advantages in the diagnosis of early pregnancy both for the patient and the physician. In the first place it is easier to perform than abdominal sonography, since a filled bladder is not a prerequisite for the examination. Secondly, the intrauterine location of the pregnancy can be diagnosed as early as the 37th day of gestation. Thirdly, diagnosis of a disturbed intrauterine or an extrauterine pregnancy is possible earlier than with the abdominal approach. Vaginal sonography thus frequently reduces the period of anxious waiting for the patient and, where necessary, enables the physician to operate early with the least possible traumatization.

[Correlation of blood pressure and cadmium and lead content of the hair in nonsmoking males]. / Untersuchungen zum Zusammenhang zwischen dem Blutdruck und dem Cadmium- und Bleigehalt in den Haaren nichtrauchender Männer.

In developed countries, hypertension represents one of the most frequent diseases and is one of the most important risk factors of arteriosclerotic vascular disease e.g. to myocardial infarction or cerebral apoplexy. The etiology of hypertension is unknown in about 90% of cases. The heavy metals cadmium and lead occur in increasing amounts in the human environment. Numerous epidemiological studies and investigations using experimental animals have dealt with the putative relationship between cadmium and lead, and hypertension. The results to date have been quite controversial; thus the issue appears to be unresolved at present. In the present study scalp hair samples were collected from 100 non-smoking 30-to-50-year-old men. After washing, the samples were digested with a mixture of nitric and sulfuric acid in a teflon bomb and analyzed by flameless atomic absorption spectroscopy. For 90% of the test persons the cadmium hair values were in the range of 0 to 1400 micrograms/kg; the corresponding range for hair lead was 0 to 13,000 micrograms/kg. Correlation with diastolic or systolic blood pressure was neither found for cadmium or lead. The test persons with the highest cadmium or lead load were not hypertensive. Some factors should be considered when comparing the present results with those of other investigators reporting a positive correlation in the question under consideration. 1. Previous studies in man frequently did not sufficiently take smoking habits into account. This is essential, however, because, in addition to cadmium and lead, nicotine and carbon monoxide are also constituents of tobacco smoke and contribute to an increase in blood pressure. 2. Previous investigations generally employed blood samples, which is disadvantageous in comparison with the analysis of hair because blood samples do not reflect long-term exposition, which is important in the etiology of chronic diseases. Correlation between hypertension and levels of long-term cadmium and lead exposure in man seem to be unlikely in light of the present results. Nevertheless, numerous potential effects should be considered to obtain further insight in the complex pathogenesis of hypertension.

Effectiveness of single versus double volume exchange transfusion in newborn infants with AB0 hemolytic disease.

The effectiveness of early single volume exchange transfusion (ET; 80 ml/kg) was compared with that of early double volume exchange transfusion (160 ml/kg) for treatment of hemolytic disease of the newborn caused by AB0 incompatibility. Twenty full-term infants with AB0 hemolytic disease were randomized into the two treatment groups. The groups were comparable for gestational age, body weight, hemoglobin values, reticulocyte count, maximum serum bilirubin levels, rate of rise of serum bilirubin before ET, antibody titer, and age at time of ET (all p greater than 0.05). The efficacy of treatment was similar in both groups taking into account the mean bilirubin level after ET, post-ET bilirubin, duration of phototherapy following ET, and frequency of second ET (all p greater than 0.05). However, platelet count immediately after ET was lower in the double volume ET group as compared to the single volume ET group (p less than 0.01). Hemoglobin values immediately after ET were higher in the double volume ET group (p less than 0.01). At ten days of life no differences were detectable. The results of this study indicate that the effectiveness of single volume ET for treatment of full-term infants with jaundice due to AB0 incompatibility is at least comparable to that of double exchange ET. Furthermore, the lesser aggressive approach determines less complications such as a decrease of platelet count.

Coagulation abnormalities in low birth weight infants with peri-intraventricular hemorrhage.

Fifty-four appropriate for gestational age preterm infants (less than 35 weeks gestation) were followed prospectively from birth with coagulation and real-time ultrasound studies. Coagulation analyses included fibrinogen, prothrombin time, thrombin time and platelet count. The occurrence of peri-intraventricular hemorrhage (PIVH) was documented by portable 5 MHz Echo Scanner. Definite PIVH was present in 21 babies (38%). Coagulation studies showed especially lower values of fibrinogen levels in babies of less than 30 weeks gestation compared to a control group without PIVH (p less than 0.03). Furthermore, significant correlation was observed in these patients between platelet count and degree of PIVH. Infants with Grade 3 and 4 PIVH had lower platelet count than infants with less severe bleeding (Grade 1 and 2) (p less than 0.02). These data suggest that hemostatic abnormalities play a major role as co-factor in the incidence and severity of neonatal PIVH in very low birth weight infants of less than 30 weeks gestation.

Biliary elimination of indomethacin in man.

The biliary elimination of indomethacin 100 mg p.o. has been investigated in patients with a T-tube drain after cholecystectomy, who had normal or abnormal liver function (Group I n = 5, and Group II n = 4, respectively). In plasma, the concentration maximum (Group I 9.5 +/- 1.4 mumol X l-1; Group II 19.4 +/- 3.8 mumol X l-1) and the total clearance (Group I 1.56 +/- 0.28 ml X min-1 X kg-1, Group II 0.5 +/- 0.06 ml X min-1 X kg-1) were significant different in the two groups. The bile:plasma ratio (bpr) in Group I was 1.3 +/- 0.33 and 10.1 +/- 3.2, respectively, for indomethacin (In) and conjugated In. The conjugated fraction of In was 87.5 +/- 1.9% of the total concentration. In Group II the bpr was lower (0.65 +/- 0.1). In is eliminated in bile by diffusion and conjugated In by active secretion. In Group I 0.99 +/- 0.1 mg In and 6.1 +/- 0.7 mg conjugated In and in Group II 2.1 +/- 0.3 mg In (p less than 0.05) were eliminated in bile. No influence of In on the biliary lipids was observed or on the bile acid-independent fraction of bile flow. It is concluded that the total plasma clearance of In was dependent of liver function. Conjugated In undergoes enterohepatic circulation.